Provider Demographics
NPI:1184716292
Name:LETSON, AIMEE JIL (LICSW)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:JIL
Last Name:LETSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PROVIDENCE BEHAVIORAL HEALTH HOSPITAL OUTPATIENT C
Mailing Address - Street 2:1233 MAIN ST
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5394
Mailing Address - Country:US
Mailing Address - Phone:413-439-2082
Mailing Address - Fax:413-539-2436
Practice Address - Street 1:1233 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5381
Practice Address - Country:US
Practice Address - Phone:413-439-2082
Practice Address - Fax:413-539-2436
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical